Medisoft is written for a specific use and as such data processing features have been bundled together inside of the Medisoft vertical application for data manipulation and reporting.
Whereas, well known Microsoft consumer products are not vertical applications. Word and Excel from Microsoft, Wordperfect and Quattro Pro from Corel are generalized consumer applications for wordprocessing and spreadsheet respectively.
Vertical applications have a very narrow economic marketplace. IE., Medical Manager has almost 55,000 installed systems in the U.S. and Medisoft a bit more than 230,000 installed sites. But, each of Microsoft's or Corel's products often represent millions of site installations where a product might have a market value in excess of hundreds of millions of dollars. Total market value of any vertical application software is much much smaller due to the limited applicability for generalized use by the public at large.
Consequently simple application features which are bundled within Word or Excel might represent millions of dollars of investment in programmer time. For example the simple feature of apparent, automatic importing of non compatible data into a Microsoft product often has several million dollars of programmer cost to maintain compatibility to keep the data conversion feature upgraded and current. So the cost to add and maintain features which allow rapid, automatic conversion of incompatible data into a product like Word or Wordperfect costs more to implement and maintain than the total market value of some (if not most) thinly distributed vertical applications.
Therefore cost to manage any vertical application is related to size of marketplace.